CARC 192 Denial Code - Resolve Non-Standard Adjustments
Code 192 indicates that a non-standard adjustment code from a paper remittance was used to convey Coordination of Benefits (COB) information. This occurs when the adjustment cannot be mapped directly to standard deductible, coinsurance, or copayment codes. Code 192 is specifically for use within the 837 transaction when communicating with another payer.
Who Pays: Group Code Liability
For code 192, the group code usually falls under OA (Other Adjustment) since it's an informational code used for COB purposes. The patient is generally not billed for this adjustment as it's not related to patient responsibility or contractual obligations.
Why Claims Get Code 192
- The payer received a paper remittance with a non-standard adjustment code.
- The adjustment relates to Coordination of Benefits but doesn't map to deductible, coinsurance, or copayment.
- A secondary payer requires additional COB information that doesn't fit standard codes.
- The initial claim submission included incomplete or unclear COB details.
How to Fix & Resubmit
- Review the paper remittance to identify the non-standard adjustment code used.
- Check with the payer to understand the specific COB information they require.
- Ensure all COB-related information is correctly included in the 837 transaction.
- Contact the payer for guidance on how to map the non-standard adjustment to standard codes, if possible.
- Resubmit the claim with correct COB information if required.
Corrected Claim or Appeal?
For code 192, correcting the claim by accurately providing COB information is usually the solution. Appeals are not typically relevant unless payer guidance indicates an error in processing.
Preventing Future 192 Denials
- Ensure all COB details are clear and complete before submitting claims.
- Use standard codes whenever possible to avoid non-standard adjustments.
- Communicate with payers to understand their specific COB reporting requirements.
- Regularly audit claims for accurate COB information to prevent remittance errors.